Teaching skills in communication to medical students— a critical review of the methodology

Over the past decade, there has been a substantial increase in papers concerned with training medical students in communication skills. In this paper, we consider what constitutes an adequate methodology for such research and whether recent papers meet this standard.     

The effect of a spaced sex education course on medical students'' sexual knowledge and attitudes

This paper reviews the literature and emphasizes the rapid expansion of medical sex education, which has created a diversity of course content, curriculum timing and strategies. One variable of medical sex education programmes is whether they are massed or spaced courses. The authors conducted testing on 159 first year medical students who took a spaced sex education course. Significant changes in cognitive knowledge as well as attitudinal tolerance of others is reported. No changes were found in styles of thinking as measured by the Rokeach Dogmatism Scale.     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

The role of actors in teaching communication

This paper describes a series of communication workshops designed to improve the consultation skills of third-year clinical medical students during their period of attachment in general practice, and to enable them to understand the differences in perspective and attitude existing between doctor and patient and their effect on the process and outcome of the clinical interview. The workshops involve a group of professional actors as simulated patients. The advantages of this method are discussed in terms of increased lay participation in the teaching.     

Formal instruction in United Kingdom medical schools about death and dying

The paper reports the findings of a short questionnaire survey of medical schools conducted in June 1983. All U.K. schools replied. Only four schools do not provide formal instruction about death and dying for all their students.     

The ATP 30—a scale for measuring medical students' attitudes to psychiatry

The development and validation of a thirty item, Likert-type scale designed to measure medical students' attitudes to psychiatry—the ATP-30 (Attitudes Toward Psychiatry—30 items)—are described. We had hoped to demonstrate that 'attitude to psychiatry' was not a unitary matter but an amalgam of attitudes to a number of things to do with psychiatric practice. This hope was not fulfilled, as a unitary dimension was obtained. A positive change in the attitudes of students toward psychiatry was demonstrated in third and fourth medical year students in relation to exposure to psychiatry. Such a change was not demonstrable in two classes of occupational therapy students exposed to a course in psychiatry. The reasons for this difference between medical students and occupational therapy students are discussed—there possibly being important implications here for psychiatric curriculum planning in medical school. Lastly, we have demonstrated that the positive change in attitudes amongst medical students was transient rather than lasting—a matter which most studies of attitude change do not address. In spite of the apparent impermanence of the positive change in attitudes among medical students, there are a number of possible uses to a scale such as the ATP-30, and these are discussed.     

Health promotion projects: skill and attitude learning for medical students

OBJECTIVES: The aim of this health promotion project is to introduce students to appropriate skills and attitudes--as well as knowledge about health promotion strategies and methods. As part of this process, standardized procedures have been established to ensure that the projects are scientifically and ethically appropriate and adequately supervised. This project-centred course introduces the discipline of health promotion to third-year medical students at Monash University. It is aimed at introducing students to the range of health promotion concepts, providing them with experience of health promotion activities and involving them in consideration of the scientific, political and ethical issues arising from doctors' participation in health promotion. DESIGN: As the major learning and assessment component of the unit, students participate in self-selected project groups of three to five students. Each group develops a topic for a health promotion activity in the community, carries out that project and presents the results as a poster as well as a written report. SETTING: Monash University. SUBJECTS: Third-year medical students. RESULTS: Sixty per cent of each student's mark for the unit is based on the project. The posters produced by the project groups are placed on public display in a major teaching hospital for a week at the end of the unit. Public display of the posters helps each student to appreciate the variety of possible health promotion activities, and to appreciate health promotion as a scientific discipline. It also makes the project findings available to the public. CONCLUSIONS: Student evaluation of the project, and community response to the projects--especially the poster display-- indicate that the project is both a highly effective learning experience and a health-promoting activity in its own right.     

Integrating general practice tutors into an undergraduate programme

Eighteen tutors appointed to the Department of General Practice at Dundee were visited. They provided information for a study to determine the degree of their involvement in the Department. A structured questionnaire standardized the interview and the results are described. The study showed a considerable level of success in integrating this group of practitioners into the teaching activities of the Department. Results also suggested that some educational objectives were not clearly defined, and surprisingly there appeared to be an underuse of this group of motivated teachers.     

Student perceptions of the learning environment in a new medical school

Students' perceptions of their learning environment in the Faculty of Medicine of the University of Newcastle were tested in 1979, in the second year of the school's existence, when the first two cohorts of students were surveyed. It was thought important to re-test those same cohorts in 1982, when they were in the later years of the curriculum, to see whether their perceptions had changed, and also to test the perceptions of subsequent cohorts of students (still in the earlier years of the course) to examine whether the favourable perceptions of the earlier cohorts were being maintained. Accordingly, this paper reports the results of a cross-sectional study undertaken on all five years of Newcastle medical students in 1982, and it compares their perceptions with those obtained 3 years earlier.     

Developing medical student competence in lifelong learning: the contract learning approach

How contract learning may be used in the introduction to clinical medicine is described, with the goal to develop and enhance self-directed learning skills and attitudes of first- and second-year medical students. Essential tasks associated with successful self-directed learning are cited, and the contract method is described as a means for providing medical students with the opportunity to practise these tasks in the study of gerontology. The procedures followed in the implementation of the contract learning method are described, and its impacts on both need and motivation to continue learning about ageing and skills in directing independent learning projects are analysed and discussed. In addition, the implications of early preparation for doctor's lifelong learning are discussed.     

Student perceptions of a new integrated course in clinical methods for medical undergraduates

CONTEXT: In line with recent General Medical Council recommendations a new, 8-week integrated course in clinical methods has been introduced into the undergraduate curriculum at Leicester University. OBJECTIVES: To describe student perceptions of the course and to identify areas for improvement. DESIGN: A questionnaire survey. SETTINGS: These were 50 general practices, three teaching hospitals and the academic Department of General Practice and Primary Health Care. SUBJECTS: A total of 180 third- and fourth-year medical students. RESULTS: The questionnaires were completed by 93% of students. The latter expressed higher satisfaction with practice teaching compared with hospital teaching, on a 5-point scale, with regard to questions on 'teaching content' (4.0 vs. 2.7, P < 0.0001) and 'teaching process' (4.1 vs. 2.7 P < 0.0001), which was reinforced by free text comments. Of the respondents, 92% agreed that their teaching practice had satisfied the required teaching timetable and 87% of students found their departmental tutor enthusiastic and stimulating. CONCLUSION: It is possible to deliver an integrated course in clinical methods, teaching generic clinical skills, in a mix of hospital and practice settings. Nevertheless there were substantial differences in student perceptions of the relative quality and impact of teaching in the two settings. This may be related to the more detailed programme of preparation of practice teachers and the greater extent to which practice teachers were required, and able, to create protected time for the teaching task. These differences should be minimized if hospital teachers undergo similar preparation for the teaching task and have similar levels of protected teaching time.     

Toward a clinical orientation in the basic medical biochemistry curriculum

A re-evaluation of biochemistry in medical school curricula is presented, with reference to designing more effective courses. Responses to a survey conducted among 103 medical students enrolled in two general biochemistry courses indicated that basic biochemistry would be considered more relevant to the medical curriculum if clinical applications were emphasized over basic principles. A majority of students (91%) expressed interest in applying bio-chemical principles to pathological conditions. They recommended that the biochemistry curriculum should include lectures on the significance of bio-chemistry in medical practice and its role in the life processes, laboratory comparisons of normal and pathological specimens, and course titles that reflect a more clinical orientation.     

Upstairs, downstairs: Medical students in their first clinical year and their previous experience of work in hospitals

In a study of Edinburgh students in their first clinical year it was found that a sizeable proportion had had some prior experience of hospital life and work from vacation jobs--such as being porters, auxiliary nurses and so on. Students' retrospective accounts of such experience are reported. The most salient aspect of hospitals seen from this vantage point concerned the division of labour between grades of staff, and the hierarchical organization of hospital personnel. Students saw the experience primarily as a chance to see medicine 'from the other side'. It is suggested that such experiences can be drawn on in the teaching of sociology to undergraduate students.     

Undergraduate psychiatry teaching in Ethiopia

Many epidemiological studies have shown the magnitude and seriousness of mental disorders in developing countries. However, mental health care remains unsatisfactory owing to lack of skilled manpower and many other social and medical priorities. General practitioners and other health personnel can significantly help in extending mental health care provided they receive adequate training during their medical curriculum. With this aim, the Department of Psychiatry at Addis Ababa University runs a 6-week full-time course for undergraduate medical students. Its chief objectives, teaching methods, achievements and shortcomings are discussed in the paper.